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Topical Traditional Chinese Medicine
A Report From Singapore
See-Ket Ng, MBBS, MEd, (Int Med)
Arch Dermatol. 1998;134:1395-1396.
ABSTRACT
Topical traditional Chinese medicine is still widely used, especially by those of Chinese descent in Singapore. This practice is likely to be similar wherever there is a sizable Chinese community. In this article I discuss the types of topical traditional Chinese medicine available in Singapore—emphasizing particularly the ingredients used in the making of them—in an attempt to dispel some myths and misconceptions about traditional oils and balms.
INTRODUCTION
The use of traditional medicated oils and ointments is still prevalent among the Chinese community in Singapore. These topical traditional Chinese medicines (TTCMs) are sold, alongside Chinese herbal medicine, in traditional Chinese medicine shops all over Singapore. Pharmacies in Singapore also almost always have a small section where these are displayed for sale.
There are many varieties of TTCM available in Singapore. Some are manufactured in Singapore. Others are imported from the surrounding region, particularly from Malaysia, Hong Kong, and China.
A common misconception—and this is due first to the myriad of preparations available, and second because of labeling, with brands like Tiger Balm, 3-Snake Oil, Dragon Balm, and Red Flower Oil—is that TTCM is a complicated, exotic art, with ingredients that are incomprehensible and often secrets. In reality, TTCM in Singapore, and this is probably also true in places where there is a sizable Chinese community, eg, in Hong Kong, Taiwan, and Chinatowns in Europe and the United States, is not at all a difficult topic.
First and foremost, it must be appreciated that brand names are just brand names, and do not indicate the type of ingredients in the TTCM, eg, Tiger Balm and 3-Snake Oil do not contain any material from these 2 animals.
Second, all these myriad of preparations can be grouped into 3 classes, according to usage. In each class, the ingredients revolve around a common theme, with only minor differences, aptly described by one retailer as "if you have seen one, you have seen them all." The 3 classes of TTCM are listed below.
OILS AND OINTMENTS FOR ACHES AND PAINS
The bulk of TTCM in Singapore is used for the soothing of headaches, abdominal pain, especially in children, and rheumatic pains. These oils and ointments are also used for relief of insect bites and itchy skin lesions. A classic example of TTCM in this category is Tiger Balm. The TTCMs used for this purpose usually contain camphor and menthol and also 1 or more essential oils, the common ones being cinnamon oil, oil of clove, cassia oil, citronella oil, oil of lavender, or cajuput oil. These are compounded together in a base oil or petrolatum.
It can be appreciated therefore that these preparations are meant to be soothing. They are not an irritant to the skin. It is, however, evident that patients who are allergic to fragrances would likely react adversely to this category of TTCM. In Singapore, patients who on patch testing react positively to fragrance mix or balsam of peru would be instructed to avoid, in addition to fragance compounds, all TTCM. Nearly all TTCM in this category can be patch tested as is.
A subclass of this category of TTCM is preparations used for rheumatic pains. These would have in addition to menthol, camphor, and essential oils, methyl salicylate or oil of wintergreen. Patch testing with this subclass is best done diluted to 10% in petrolatum.
OILS AND OINTMENTS FOR ORTHOPEDIC INJURY
This is a rather specialized category of TTCM, used to soothe and promote the healing of injury, especially bruised and contused muscle. In my mind, this is what most would consider the classic TTCM, associated with the pugilistic arts. Prototype of this category would be Tjin-Koo-Lin (balm for tendons and bones). This category usually contains, in addition to camphor, menthol, essential oils, and methyl salicylate, extracts of herbs, usually of many kinds. This is illustrated by the contents of a Tjin-Koo-Lin manufactured in Singapore (Table 1).
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Contents of a Tjin-Koo-Lin (Balm for Tendons and Bones) Manufactured in Singapore*
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In a study to determine the allergenic fraction in this category of TTCM, Lee and Lam1 found the culprit allergens to be mastic and myrrh, 2 resins frequently found in the formulation of this category of TTCM.
This may be the best time to discuss Bone-setter's herbs. This is not the TTCM that is mass produced and available from shops. These are always prepared fresh, by a bone-setter (a specialized traditional Chinese healer). Herbs are pounded, mixed with wine or honey, and wrapped around injured bones or joints after manipulation. These preparations are changed daily or every other day. The poultice is not an irritant to skin and is well tolerated by many patients. Allergic contact dermatitis is, however, not uncommon. Contact allergy commonly occurs after a few changes of the poultice. The contact dermatitis appears suddenly, is of a bright dermal erythema, and almost vasculitic in appearance. In another study, Lee and Lam2 again showed the allergenic fraction to be myrrh. Patients often require a short course of oral steroids to settle the severe contact dermatitis.
OINTMENTS FOR SKIN DISEASES, USUALLY RINGWORM
The third category of TTCM is rather different from the earlier 2. These are lotions and ointments touted as efficacious for all kinds of skin diseases, particularly ringworm, which usually contain salicylic acid. One popular brand of this type of TTCM in Singapore contains 20% salicylic acid, which is certainly effective for tinea but may cause contact dermatitis if used on eczematous skin.
CONCLUSIONS
Topical traditional Chinese medicine, at least in Singapore, and probably also in Malaysia, Hong Kong, Taiwan, and Chinatowns everywhere, are really rather simple preparations. Topical traditional Chinese medicines serve to soothe the population, especially in the past, but are still of some popularity in our era. Topical traditional Chinese medicine is not at all a difficult, mystical art as some may think, despite the often exotic and fanciful brand names.
AUTHOR INFORMATION
Accepted for publication April 15, 1998.
Corresponding author: See-Ket Ng, MBBS, MEd (Int Med), National Skin Centre, 1 Mandalay Rd, Singapore 308205.
From the National Skin Centre, Singapore.
REFERENCES
1. Lee TY, Lam TH. Allergic contact dermatitis to a Chinese orthopaedic solution Tieh Ta Yao Gin. Contact Dermatitis. 1993;28:89-90.
PUBMED
2. Lee TY, Lam TH. Myrrh is the putative allergen in Bone-setter's herbs dermatitis. Contact Dermatitis. 1993;29:279.
PUBMED
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